Nose job 10 years ago: got necrosis and a scar on my nose. Please help. (photos)

To begin with, I think the cause of your atypical and evident skin necrosis was a pressure sore due to a too tight postop nasal splint, probably not one made of gypsum (which allows swelling expansion when it is not very thick) and actually one of thermoplastic molding (very very dangerous and trendy but totally unadvisable!) or a too thick and pinched and too long gypsum splint.After so many years passed by I think the skin cover has recovered; obviously the cutaneous scars are non-deletable and you'l have to accept them, but I can also tell you they are the lesser source of deformities of your nose.I have done similar cases of post-splint pressure sore noses and inside the findings are troublesome, normally there is an extense necrotic internal area affecting the alar cartilages, the cruras, the tip and the upper lateral cartilages, many of them require debridement of the so called calficied ischemic necrosis and, therefore, replacement by fresh hand made pieces grafted from septum, ears or rib, to restore the natural anatomy and the nasal harmony; findings in particular are unpredictable, not even examining you in person, since there are more than simple technical errors, we are dealing with a pressure sore damage of full thickness kind. Whateever they are have to be fixed.One main and probably the most critical step, the one requiring the finest surgical skills is not really the repair or reconstruction, the most difficult part of your rhinoplasty, taking more than 1-2 hours, is being able to perform the debridement (removal) of the damaged structures and identification of the viable ones.You need a surgeon with vast experience in revisions, very fine manual skills and a full set of reconstructive resources to face the repairing strategy, which would be planned intraoperatively once the anatomy is debrided and assessed.Difficulty 10 out of 10 in revisions... actually it is more a reconstruction rhinoplasty... surgical time 6-7 hours; do research well who'll do your nose, it is the last chance you'll have.If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Scars are permanent. But The depressed scar on the nose can be improved by scar revision.It may require a z-plasty, but that needs to be decided by an in person examination.Laser after that may soften the scar further.